Incidence and Factors Associated With Cognitive Impairment 90 Days After First Ever Ischemic Stroke

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2025-04-26 DOI:10.1002/gps.70087

Małgorzata Dec-Ćwiek, Paweł Wrona, Tomasz Homa, Joanna Słowik, Aleksandra Bodzioch, Agnieszka Słowik

{"title":"Incidence and Factors Associated With Cognitive Impairment 90 Days After First Ever Ischemic Stroke","authors":"Małgorzata Dec-Ćwiek, Paweł Wrona, Tomasz Homa, Joanna Słowik, Aleksandra Bodzioch, Agnieszka Słowik","doi":"10.1002/gps.70087","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>Post-stroke cognitive impairment (PSCI) is prevalent among stroke survivors, negatively impacting long-term outcomes. We aimed to assess the prevalence of PSCI and its risk factors in participants from the iBioStroke study (<i>n</i> = 1042), 90 days after their first ischemic stroke.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We prospectively analyzed data from 582 participants, without cognitive problems before stroke based on the structured interview with the patient, a family member or a caregiver, and/or clinical documentation (if available), who completed the Montreal Cognitive Assessment (MoCA) at discharge and 90 days post-stroke. Two MoCA cut-offs were used to define PSCI: a score of ≤ 25 in the first model and ≤ 22 in the second model. Multivariate logistic regression was employed to identify independent risk factors for PSCI based on 30 collected parameters.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In the first model, PSCI was identified in 418 (71.8%) participants at day 90. Independent risk factors included older age (OR = 1.05; 95% CI:1.02–1.08), fewer years of education (OR = 0.83; 95% CI: 0.73–0.93), lower MoCA scores at discharge (OR = 0.76; 95% CI: 0.69–0.84), higher anxiety levels (HADS-A) at day 90 (OR = 1.10; 95% CI: 1.01–1.21), and larger stroke volume (OR = 1.01; 95% CI: 1.00–1.01). In the second model, PSCI was observed in 294 (50.5%) participants. Older age (OR = 1.06; 95% CI: 1.03–1.09), fewer years of education (OR = 0.87; 95% CI: 0.78–0.96), lower MoCA scores at discharge (OR = 0.83; 95% CI: 0.77–0.88), and higher depression levels (HADS-D) at day 90 (OR = 1.10; 95% CI: 1.03–1.18) were significant predictors.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Based on our data, PSCI seems to be a common consequence of stroke. Both irreversible factors, such as age and educational level, stroke volume, and potentially modifiable factors, including post-stroke anxiety or depression and acute cognitive impairment, contribute to PSCI risk. These findings underscore the importance of early cognitive and psychiatric interventions in stroke survivors.</p>\n </section>\n </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Geriatric Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/gps.70087","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

Post-stroke cognitive impairment (PSCI) is prevalent among stroke survivors, negatively impacting long-term outcomes. We aimed to assess the prevalence of PSCI and its risk factors in participants from the iBioStroke study (n = 1042), 90 days after their first ischemic stroke.

Methods

We prospectively analyzed data from 582 participants, without cognitive problems before stroke based on the structured interview with the patient, a family member or a caregiver, and/or clinical documentation (if available), who completed the Montreal Cognitive Assessment (MoCA) at discharge and 90 days post-stroke. Two MoCA cut-offs were used to define PSCI: a score of ≤ 25 in the first model and ≤ 22 in the second model. Multivariate logistic regression was employed to identify independent risk factors for PSCI based on 30 collected parameters.

Results

In the first model, PSCI was identified in 418 (71.8%) participants at day 90. Independent risk factors included older age (OR = 1.05; 95% CI:1.02–1.08), fewer years of education (OR = 0.83; 95% CI: 0.73–0.93), lower MoCA scores at discharge (OR = 0.76; 95% CI: 0.69–0.84), higher anxiety levels (HADS-A) at day 90 (OR = 1.10; 95% CI: 1.01–1.21), and larger stroke volume (OR = 1.01; 95% CI: 1.00–1.01). In the second model, PSCI was observed in 294 (50.5%) participants. Older age (OR = 1.06; 95% CI: 1.03–1.09), fewer years of education (OR = 0.87; 95% CI: 0.78–0.96), lower MoCA scores at discharge (OR = 0.83; 95% CI: 0.77–0.88), and higher depression levels (HADS-D) at day 90 (OR = 1.10; 95% CI: 1.03–1.18) were significant predictors.

Conclusions

Based on our data, PSCI seems to be a common consequence of stroke. Both irreversible factors, such as age and educational level, stroke volume, and potentially modifiable factors, including post-stroke anxiety or depression and acute cognitive impairment, contribute to PSCI risk. These findings underscore the importance of early cognitive and psychiatric interventions in stroke survivors.

查看原文本刊更多论文

首次缺血性脑卒中后90天认知障碍的发生率及相关因素

脑卒中后认知障碍（PSCI）在脑卒中幸存者中普遍存在，对长期预后有负面影响。我们的目的是评估iBioStroke研究参与者（n = 1042）首次缺血性卒中后90天PSCI的患病率及其危险因素。方法我们前瞻性地分析了582名卒中前无认知问题的参与者的数据，这些参与者在出院时和卒中后90天完成了蒙特利尔认知评估（MoCA），基于对患者、家庭成员或护理人员的结构化访谈和/或临床文件（如果有的话）。采用两个MoCA截止值来定义PSCI：第一个模型得分≤25，第二个模型得分≤22。根据收集到的30个参数，采用多因素logistic回归分析PSCI的独立危险因素。结果在第一个模型中，418名（71.8%）参与者在第90天被确诊为PSCI。独立危险因素包括：年龄较大(OR = 1.05；95% CI: 1.02-1.08)，受教育年限更短(OR = 0.83；95% CI: 0.73-0.93)，出院时MoCA评分较低(OR = 0.76；95% CI: 0.69-0.84)，第90天较高的焦虑水平（HADS-A） (OR = 1.10；95% CI: 1.01 - 1.21)，更大的中风量(OR = 1.01；95% ci: 1.00-1.01)。在第二个模型中，294人（50.5%）出现PSCI。年龄较大(OR = 1.06；95% CI: 1.03-1.09)，受教育年限更短(OR = 0.87；95% CI: 0.78-0.96)，出院时MoCA评分较低(OR = 0.83；95% CI: 0.77-0.88)，第90天抑郁水平（HADS-D）较高(OR = 1.10；95% CI: 1.03-1.18)是显著的预测因子。根据我们的数据，PSCI似乎是中风的常见后果。年龄、教育水平、脑卒中量等不可逆因素和脑卒中后焦虑、抑郁、急性认知障碍等潜在可改变因素均可增加PSCI风险。这些发现强调了早期认知和精神干预对中风幸存者的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.